Prevalence of visual impairment in El Salvador: inequalities in educational level and occupational status.

OBJECTIVE: To examine the prevalence of blindness, visual impairment, and related eye diseases and conditions among adults in El Salvador, and to explore socioeconomic inequalities in their prevalence by education level and occupational status, stratified by sex. METHODS: Based upon the Rapid Assessment of Avoidable Blindness (RAAB) methodology, this nationwide sample comprised 3 800 participants (3 399 examined) ≥ 50 years old from 76 randomly selected clusters of 50 persons each. The prevalence of blindness, visual impairment and related eye diseases and conditions, including uncorrected refractive error (URE), was calculated for categories of education level and occupational status. Multiple logistic regression models were fitted to calculate odds ratios (ORs) and 95% confidence intervals (CIs) and stratified by sex. RESULTS: Age-adjusted prevalence was 2.4% (95% CI: 2.2-2.6) for blindness (men: 2.8% (95% CI: 2.5-3.1); women: 2.2% (95% CI: 1.9-2.5)) and 11.8% (95% CI: 11.6-12.0) for moderate visual impairment (men: 10.8% (95% CI: 10.5-11.1); women: 12.6% (95% CI: 12.4-12.8)). The proportion of visual impairment due to cataract was 43.8% in men and 33.5% in women. Inverse gradients of socioeconomic inequalities were observed in the prevalence of visual impairment. For example, the age-adjusted OR (AOR) was 3.4 (95% CI: 2.0-6.4) for visual impairment and 4.3 (95% CI: 2.1-10.4) for related URE in illiterate women compared to those with secondary education, and 1.9 (95% CI: 1.1-3.1) in cataract in unemployed men. CONCLUSIONS: Blindness and visual impairment prevalence is high in the El Salvador adult population. The main associated conditions are cataract and URE, two treatable conditions. As socioeconomic and gender inequalities in ocular health may herald discrimination and important barriers to accessing affordable, good-quality, and timely health care services, prioritization of public eye health care and disability policies should be put in place, particularly among women, the unemployed, and uneducated people.

Prevalence of visual impairment in El Salvador: inequalities in educational level and occupational status / Prevalencia de deficiencia visual en El Salvador: desigualdades según el nivel educativo y la situación laboral

OBJECTIVE: To examine the prevalence of blindness, visual impairment, and related eye diseases and conditions among adults in El Salvador, and to explore socioeconomic inequalities in their prevalence by education level and occupational status, stratified by sex. METHODS: Based upon the Rapid Assessment of Avoidable Blindness (RAAB) methodology, this nationwide sample comprised 3 800 participants (3 399 examined) ≥ 50 years old from 76 randomly selected clusters of 50 persons each. The prevalence of blindness, visual impairment and related eye diseases and conditions, including uncorrected refractive error (URE), was calculated for categories of education level and occupational status. Multiple logistic regression models were fitted to calculate odds ratios (ORs) and 95% confidence intervals (CIs) and stratified by sex. RESULTS: Age-adjusted prevalence was 2.4% (95% CI: 2.2-2.6) for blindness (men: 2.8% (95% CI: 2.5-3.1); women: 2.2% (95% CI: 1.9-2.5)) and 11.8% (95% CI: 11.6-12.0) for moderate visual impairment (men: 10.8% (95% CI: 10.5-11.1); women: 12.6% (95% CI: 12.4-12.8)). The proportion of visual impairment due to cataract was 43.8% in men and 33.5% in women. Inverse gradients of socioeconomic inequalities were observed in the prevalence of visual impairment. For example, the age-adjusted OR (AOR) was 3.4 (95% CI: 2.0-6.4) for visual impairment and 4.3 (95% CI: 2.1-10.4) for related URE in illiterate women compared to those with secondary education, and 1.9 (95% CI: 1.1-3.1) in cataract in unemployed men. CONCLUSIONS: Blindness and visual impairment prevalence is high in the El Salvador adult population. The main associated conditions are cataract and URE, two treatable conditions. As socioeconomic and gender inequalities in ocular health may herald discrimination and important barriers to accessing affordable, good-quality, and timely health care services, prioritization of public eye health care and disability policies should be put in place, particularly among women, the unemployed, and uneducated people.

OBJETIVO: Analizar la prevalencia de la ceguera, la deficiencia visual, y las enfermedades y afecciones oculares relacionadas en adultos de El Salvador, y explorar las desigualdades socioeconómicas en cuanto a su prevalencia según el nivel educativo y la situación laboral, estratificados por sexos. MÉTODOS: Se adoptó el método de Evaluación Rápida de la Ceguera Evitable, y se escogió una muestra a escala nacional de 3 800 participantes (de ellos se examinaron 3 399) de 50 años de edad o mayores, pertenecientes a 76 agrupamientos seleccionados aleatoriamente y constituidos por 50 personas cada uno. Se calculó la prevalencia de la ceguera, la deficiencia visual y las enfermedades y afecciones oculares relacionadas, incluido el error de refracción no corregido, según las diferentes categorías de nivel educativo y situación laboral. Se emplearon modelos de regresión logística múltiple para calcular las razones de posibilidades (OR) y los intervalos de confianza (IC) de 95%, y se estratificaron por sexos. RESULTADOS: La prevalencia ajustada por edad fue de 2,4% (IC de 95%: 2,2-2,6) para la ceguera (hombres: 2,8% [IC de 95%: 2,5-3,1]; mujeres: 2,2% [IC de 95%: 1,9-2,5]) y de 11,8% (IC de 95%: 11,6-12,0) para la deficiencia visual moderada (hombres: 10,8% [IC de 95%: 10,5-11,1]; mujeres: 12,6% [IC de 95%: 12,4-12,8]). La proporción de deficiencias visuales debidas a catarata fue de 43,8% en los hombres y de 33,5% en las mujeres. En la prevalencia de la deficiencia visual se observaron gradientes inversos de desigualdades socioeconómicas. Por ejemplo, la OR ajustada por edad fue de 3,4 (IC de 95%: 2,0-6,4) para la deficiencia visual y de 4,3 (IC de 95%: 2,1-10,4) para el error de refracción no corregido relacionado en las mujeres analfabetas, en comparación con las que tenían un nivel de educación secundaria, y fue de 1,9 (IC de 95%: 1,1-3,1) para la catarata en los hombres desempleados. CONCLUSIONES: La prevalencia de ceguera y deficiencia visual es alta en la población adulta de El Salvador. Las principales afecciones asociadas son la catarata y el error de refracción no corregido, ambas tratables. Puesto que las desigualdades socioeconómicas y de género en materia de salud ocular pueden ser indicativas de discriminación y de la existencia de barreras importantes para obtener acceso a servicios de atención de salud asequibles, de buena calidad y oportunos, es preciso dar prioridad a la atención oftalmológica pública y a las políticas dirigidas a corregir la discapacidad, en particular en las mujeres y en las personas desempleadas y sin formación.